Use of N-acetyl-cysteine to Prevent Nephrotoxicity Associated with Iodinated Contrast Agents

Contrast induced nephropathy (CIN) is an iatrogenic form of acute kidney injury (AKI) with variable but growing prevalence secondary to increased need for contrast administration during medical investigations such as coronary angiography. The mechanism of CIN is complex and poorly understood but is believed to be secondary to renal medullary hypoxia secondary to direct tubular toxicity from the contrast media and vasoconstriction. N-acetylcysteine (NAC) an antioxidant and vasodilator, has shown promising results in early investigations but failed to demonstrate consistent results in subsequent clinical trials and their meta-analysis. In this review we aim to discuss pharmacological properties of NAC and appraise the literature regarding the use of NAC for the prevention of CIN after coronary angiography.